Current Treatment of Angioedema Induced by ACE Inhibitors

Abstract

Purpose of Review Angioedema is a well-known side effect of ACE inhibitors. Current knowledge shows that the underlying pathophysiological mechanism is an excess of bradykinin, most likely due to ineffective breakdown pathways. Since C1 inhibitor deficiency has the same pathophysiological background, it would be logical to assume that C1 inhibitor deficiency treatments could be of use in ACE inhibitor-induced angioedema. The objective of this review was to evaluate the evidence for treatment of ACE inhibitorinduced angioedema by means of drugs intervening in the bradykinin system. Recent Findings We searched in the literature for double-blind placebo-controlled trials using either inhibitors of production of kallikrein, bradykinin receptor antagonists, C1 inhibitor concentrate, or fresh frozen plasma as treatment for ACE inhibitor-induced angioedema. The reference list of retrieved articles was checked for articles with the same subject (snowballing). The evidence for each treatment was evaluated by IT and DMC. Summary Double-blind placebo-controlled trials were only found for ecallantide and icatibant. Both treatments did not show superiority over conventional treatment with histamine receptor antagonists and steroids. No double-blind placebo-controlled trials were found of fresh frozen plasma or C1 inhibitor concentrate. To date, there is insufficient evidence for the use of bradykinin receptor antagonists and kallikrein production inhibitors. Although case reports regarding the use of fresh frozen plasma and C1 inhibitor concentrate are positive, well-designed trials are lacking. Drug Allergy (L Mayorga, Section Editor)

Case Report: Compromised Airway Following Anesthesia and Its Correlation With the Use of ACE Inhibitors—An Unexpected Clinical Event and Review of Literature

“…Up to 20% of cases may present with dysphonia and stridor with rapid progression to life-threatening airway obstruction ( 10 ). Therefore, the airway should always be evaluated by an ear–nose–throat (ENT) specialist in these cases by fiberoptic nasal endoscopy to formulate airway management plan ( 13 ). Involvement of soft tissue neck may make cricothyrotomy, trans-tracheal jet ventilation, and tracheostomy difficult ( 10 ).…”

“…The current therapeutic options of ACE-IA are insufficient and unsatisfying as only off-label therapy options are available and previous study results are incongruent ( 5 ). Despite the potential severity of this disease state, there is no consensus regarding emergency pharmacological management of these episodes ( 13 ).…”

Angiotensin-converting-enzyme inhibitor–induced angioedema

“…2 Randomized trials do not support the use of bradykinin receptor antagonists (icatibant) and kallikrein inhibitors (ecallantide). 1,4 Fresh frozen plasma and C1-inhibitor concentrate have reportedly reduced symptom duration in case studies, but have not been tested in trials. 1,4 PRACTICE | FIVE THINGS TO KNOW ABOUT ...…”

Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema

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